The present study examined cross-sectional and longitudinal developmental characteristics of the association between mental health and substance use. N=1182 adolescents aged between 11 and 20 years were recruited from schools in Australia. Participants completed the Youth Self Report (YSR) (Achenbach, 1991a) and reported on their use of alcohol, tobacco, and marijuana, their social ability, their motivation for using substances, their ability to regulate emotion, and the influences of their parents and peers on their substance use. N=561 of time one participants were retained for testing one year later to assess the potential to predict substance use at time two from mental health at time one. Results indicated a clear and consistent cross-sectional association between externalising scores on the YSR and use of the three substances, regardless of gender. The relation between internalising scores and substance use was non-significant. When the relation between externalising scores and substance use was assessed for mediation, only the influence of parents and peers was found to be significant. A cross-sectional structural model developed to account for this association was demonstrated to be invariant across the three substances of interest, and across gender, but not age category. There was no evidence that social skills, emotion regulation, or substance use motives, had roles in mediating the relationship between mental health and substance use. A model was developed to assess the potential to predict substance use at time two from externalising scores at time one. Results showed that externalising scores predicted increases in alcohol use via parent and peer attitudes. Thus, externalising disposition, in the context of a facilitative social environment, was predictive of an increase in alcohol use over time. Structural models developed to account for the predictive relation between externalising scores and use of cigarettes and marijuana proved unstable and could not be tested. Substance use at time one was not predictive of externalising scores at time two. The results of the present research are discussed in relation to their potential to inform the developmental substance use literature, and efforts directed against the development of substance use problems. Limitations of the present research are noted.

Psychotropic drugs are mind affecting compounds. They range in type from illegal narcotic analgesics such as heroin, to prescribed major tranquillisers used for treatment of psychotic states, to prescribed minor tranquillisers such as the benzodiazepines, Valium and Mogadon, to the freely available, over the counter drugs, Aspirin and Panadol. Overseas and Australian data show the minor tranquilliser group, benzodiazepines, first introduced on the pharmaceutical scene in the early 1960s, to be the most commonly prescribed psychotropic drugs. Their popularity with medical practitioners as prescription drugs for conditions of anxiety, stress, insomnia and some forms of epilepsy, arises from the advertised inference by drug companies that they are free from any side effects in the patient such as dependence, tolerance and on termination of treatment, absence of withdrawal syndrome. Benzodiazepines were first introduced as a substitute for the well known dependence producing barbiturate based sedatives. Overseas and Australian data show women are prescribed psychotropic drugs, particularly benzodiazepines, twice as often as men and in many instances for conditions unrelated to those for which the drugs are recommended. Australian data comes from two sources, official statistics such as the Pharmaceutical Benefits Scheme and from surveys of drug use. Both sources of data are incomplete, inaccurate and in many cases misleading. The true picture of prescribed psychotropic drug use in Australia therefore lacks resolution and in all probability underestimates prevalence and patterns of use in the community. There is no data on the prevalence and patterns of use of prescribed psychotropic drugs in the Australian Capital Territory. It was therefore deemed appropriate to conduct a survey to determine their prevalence and patterns of use. The survey was confined to women for several reasons: Women are a target group in the Commonwealth and State Government 'Drug Offensive'; evidence from studies overseas and in Australia shows that women are prescribed psychotropic drugs, particularly benzodiazepines, twice as often as men; Australian data suggests that this trend is uniform and therefore the Australian Capital Territory should be no different. Data shows that doctors, particularly General Practitioners, are the main source of prescribed psychotropic drugs. The main psychotropic drugs prescribed by general practitioners are benzodiazepines. It was therefore deemed appropriate to conduct a survey of general practitioner's attitudes, knowledge and beliefs about the appropriate use of benzodiazepines as these factors carry weight in a doctor's prescribing habits. The survey of women was conducted using a standardised, structured, telephone survey on a random sample of 120 women in the Australian Capital Territory. The results of the survey show that 40% of the sample had used prescribed psychotropics at some stage in their lives. Most users were older women, married, well educated and working full time. Level of knowledge about the drug was low, compliance with respect to use was high. Most prescribed psychotropic drugs were obtained from a doctor. There appears to be little drug sharing or concurrent drug use. Half of the prescribed psychotropics were benzodiazepines the other half were mostly anti-depressants. Use of over the counter psychotropics was very high. The survey of general practitioners was conducted using a standardised, structured mailed questionnaire distributed to a random sample of 25 general practitioners in the Australian Capital Territory. The results show the majority of doctors prescribe the drugs for common indications (anxiety, stress, insomnia and some forms of epilepsy) in excess of one week. For specific anxiety states however, most prescribe the drugs along with some form of counselling. The majority of doctors (77%) think counselling is not as effective as drug treatment. All doctors surveyed think patients should be advised of the drugs effects on driving and machinery operation; the drugs should not be shared with others; that the drugs should not be terminated abruptly; the drugs should not be used concurrently with alcohol. The majority (92%) believe benzodiazepines are over prescribed and most doctors (77%) believe the drugs produce dependence in patients. The majority (58%) believe women of child bearing age are at risk using benzodiazepines while 50% think pregnant women are at risk. The majority of doctors did not believe that people older than 60 years of age are at risk but most believe children are at risk. The findings of both surveys have implications for health educators and others with a concern for drug education in the community. Recommendations arising from this study have been made. They are presented at the conclusion of this thesis.

Much-needed research on Thai adolescents (age 15-19), the fastest growing group of AIDS victims in Thailand, this study differentiates risk behavior among classes, unlike most AIDS research in Thai society, and focuses on how gender and economic factors among adolescents influence their risk-behavior patterns leading to the contraction of HIV/AIDS. Using ethnographic methods focusing on class and gender, I identified several risk-taking behaviors. Each class in Thai society tends to be at-risk from a different level of sexual relationships and drug use. The lower class seems to be the most at risk because of having many sexual partners, having unprotected sex, and sharing needles while, those in the middle class use only personal screening for their sexual partners and also sharing needles. Although the higher class is less at risk compared with other classes, a few do visit prostitutes and consume drugs. Class is also correlated to the level of knowledge and education about AIDS. Although each received the same health education provided through the same source and same health text, adolescents in each class catch the message differently. My research data showed that adolescents of the higher class showed a more complete knowledge about AIDS. There are also many patterns of HIV/AIDS risk-taking behaviors that correlate to cultural gender differences. Although all classes appear to adhere to the ideal norm of virginity being the best sexual-practice, in reality, this only applies to members of the upper class. The middle and, especially, the lower classes do not apply this norm to themselves at all: They practice premarital sex, even though they may verbalize the ideal norm. Other studies have focused on gender relations according to this ideal Thai norm; however, this ideology does not match the reality. In conclusion, with the lack of research in this area, Thai adolescents are being placed at greater risk. Thus, I make recommendations for further research and prevention methods. For example, health education should be more up-to-date and explain to adolescents the connection between sexual relationships and AIDS rather than focusing primarily on the reproductive process. Further, parents, schools, and teenagers themselves can visit with health professionals at the hospitals and anonymous clinics to learn more about STDs, especially, HIV/AIDS. If put into practice, these recommendations will positively reduce the spread of AIDS in Thailand. / Graduation date: 1999

This dissertation sought to identify correlates of perceived self-efficacy to disclose drug use to one’s HIV primary care provider (DISDR) among a sample of HIV-positive injection drug users (IDUs). Additionally the relationship between identified correlates and DISDR was evaluated to determine whether it persists longitudinally. Potential correlates consisted of individual characteristics (socio-demographic), health care service utilization, sex/drug use behaviors, and psychosocial characteristics. It was postulated that selected variables from these domains would be associated with DISDR. This study presents baseline and longitudinal data that suggest a positive association between self-efficacy to disclose injection drug use to one’s HIV primary care provider and the following variables: patient-provider relationship, attendance of a drug treatment program during the previous six months, “taking control of one’s healthcare,” and social support. However, current receipt of HIV medications and being recruited from the city of Miami were negatively associated with reporting a high DISDR. These findings will potentially inform interventions that can improve HIV treatment among drug users and inform policymakers and stakeholders regarding the importance of providing comprehensive HIV care in conjunction with substance abuse treatment options to achieve optimal health outcomes. A recommendation for further study is enclosed.

Relapse is a common occurrence in the treatment of adolescent substance abuse. It is estimated that one out of three adolescents will relapse after treatment termination. Although much attention has been given to family factors which influence an adolescent's use and abuse of drugs, this same vigorous attention has not been given to determining if family factors play a role in an adolescent resuming drug use after treatment termination. It has been theorized that the same family factors which increase the risk of an adolescent to use and abuse drugs also can help in gaining an understanding of why relapse occurs. Three prominent theories used to explain family factors associated with drug use/abuse and relapse are genetic and social learning theories, and family dysfunction. The purpose of this study was to investigate if familial factors, as proposed from the theories presented, were predictive of relapse. The sample in this study consisted of 31 adolescents who entered drug treatment between 1986 and 1988. Follow-up data of the adolescent's pattern of drug use since treatment discharge were collected through telephone interviews with the parent or guardian of the adolescent one and a half to nineteen months after treatment. The family information used in this study was collected through self-report questionnaires given to the adolescent at time of treatment. Specific family variables used in this study were: parental and sibling substance abuse history, number of parents in residence, past experience of physical and/or sexual abuse, and history of running away from home. Regression analyses were used to assess if these family variables were associated with relapse. Results of the data analyses found partial support for genetic and social learning theories of relapse, as well as relapse from a family dysfunction perspective. Findings indicated that adolescents who lived with only one parent or neither parent in comparison to those who lived with both parents, those who had experienced physical and/or sexual abuse, and those who perceived their father as not having a history of substance abuse were more at risk to relapse. Findings further indicated a cross-gender effect in that male adolescents who reported mother as having a substance abuse history were more likely to relapse. This same finding was not found for females in this study. The results indicate that given specific family dynamics, a sub-population of adolescents may be targeted on entrance to treatment to be at greater risk to relapse. / Graduation date: 1991

The transmission and prevalence of Hepatitis C Virus (HCV) among those who use injection drugs is a major public health issue. Injection drug use has been identified as the main cause of transmission for HCV in Canada. Street youth are at risk for acquiring HCV due to injection drug use that is often a consequence of living in a street environment. Presently, research on prevalence trends, characteristics, and associated behaviors for injection drug use and HCV in street youth, is limited. <p>The purposes of this study were to determine prevalence of injection drug use and HCV in Saskatoon street youth, to identify demographic or other factors that may contribute to street youth using injection drugs, and to identify risk factors and other characteristics of street youth associated with HCV. This study utilized data from Phase III of the Enhanced STD Surveillance in Canadian Street Youth Study by Health Canada for those participants recruited from Saskatoon, Canada. Between February and July 2001, 186 Saskatoon street youth participants between the ages 14 and 24 years completed nurse-administered questionnaires and of these, 156 provided blood specimens. Analyses were conducted to compare population characteristics between street youth who have used injection drugs and those who had not. Similarly, population characteristics were analyzed among those street youth who were antibody-HCV positive and those that were antibody HCV negative.<p>In this study 32.3% of 186 participants had used injection drugs. Significant associations with injection drug use were found for older age (p = 0.01), having sexual partners that use injection drugs (p = 0.01), history of incarceration (p = 0.01), and history of living on the street (p = 0.02). Significant interactions were found for sex trade work by gender (p < 0.01) and by age (p = 0.03), and for living on the street by age (p = 0.02). A HCV prevalence rate of 9.3% of 156 participants was determined for Saskatoon street youth. Use of Ritalin by injection (p = 0.04) and history of living on the street (p = 0.05) were found to be significant risk factors associated with HCV. The interaction of living on the street by gender was also significantly associated with HCV (p = 0.05). <p>The relationship identified between HCV and injection drug use in Saskatoon street youth was a history of living on the street. This link between could serve as a valuable marker for use of injection drugs and developing HCV infection in street youth. Nurses are encouraged to seek out street youth social networks to provide health care and messages of health promotion and disease prevention. Strategies that are culturally, socially, and developmentally appropriate are needed to keep these youth off the streets in the first place.

This study investigated the prevalence of workplace drug prevention programs with regards to employee drug policies, drug testing, and employee assistance programs in a sample of Oregon manufacturing companies. The objectives of the study included: 1) identifying the contributing factors that supported the decision to implement or not implement a workforce drug policy and or a drug testing program; 2) identifying the different drug testing programs in use; 3) assessing how companies evaluated their drug testing programs; and 4) identifying the drug abuse-related services being provided through company employee assistance programs. A sample of 152 Oregon manufacturing companies with 100 or more employees was obtained from the Directory of Oregon Manufacturers, 1989-1990. A researcher-designed instrument was used to collect the information. Statistical procedures used for data analysis included frequency distribution, cross tabulation, and chi square. Approximately 80 percent of the manufacturing companies surveyed had a written workplace drug policy (83 percent) and a drug testing program (81 percent). In addition, 75 percent of the organizations had an employee assistance program which provided drug abuse-related services. Differences between manufacturers with drug polices and those without policies were not significant when comparisons were made based on company size and industry classification. Statistically significant differences were found between companies utilizing drug tests and those not testing when comparisons were made based on company size and industrial classification. Companies with drug testing programs (n= 123) administered tests to both job applicants (97 percent) and employees (92 percent). Applicants testing positive for drug use were not hired by most companies (93 percent), while "positive" employees were often (76 percent) referred to an employee assistance program. Few organizations (32 percent) attempted to measure the effectiveness of their testing program. Recommendations for further research included examining the drug prevention programs in a sample of all Oregon businesses. In addition, research should assess the perceptions of workers in Oregon with regards to the issue of workplace drug testing. / Graduation date: 1992

The transmission and prevalence of Hepatitis C Virus (HCV) among those who use injection drugs is a major public health issue. Injection drug use has been identified as the main cause of transmission for HCV in Canada. Street youth are at risk for acquiring HCV due to injection drug use that is often a consequence of living in a street environment. Presently, research on prevalence trends, characteristics, and associated behaviors for injection drug use and HCV in street youth, is limited. <p>The purposes of this study were to determine prevalence of injection drug use and HCV in Saskatoon street youth, to identify demographic or other factors that may contribute to street youth using injection drugs, and to identify risk factors and other characteristics of street youth associated with HCV. This study utilized data from Phase III of the Enhanced STD Surveillance in Canadian Street Youth Study by Health Canada for those participants recruited from Saskatoon, Canada. Between February and July 2001, 186 Saskatoon street youth participants between the ages 14 and 24 years completed nurse-administered questionnaires and of these, 156 provided blood specimens. Analyses were conducted to compare population characteristics between street youth who have used injection drugs and those who had not. Similarly, population characteristics were analyzed among those street youth who were antibody-HCV positive and those that were antibody HCV negative.<p>In this study 32.3% of 186 participants had used injection drugs. Significant associations with injection drug use were found for older age (p = 0.01), having sexual partners that use injection drugs (p = 0.01), history of incarceration (p = 0.01), and history of living on the street (p = 0.02). Significant interactions were found for sex trade work by gender (p < 0.01) and by age (p = 0.03), and for living on the street by age (p = 0.02). A HCV prevalence rate of 9.3% of 156 participants was determined for Saskatoon street youth. Use of Ritalin by injection (p = 0.04) and history of living on the street (p = 0.05) were found to be significant risk factors associated with HCV. The interaction of living on the street by gender was also significantly associated with HCV (p = 0.05). <p>The relationship identified between HCV and injection drug use in Saskatoon street youth was a history of living on the street. This link between could serve as a valuable marker for use of injection drugs and developing HCV infection in street youth. Nurses are encouraged to seek out street youth social networks to provide health care and messages of health promotion and disease prevention. Strategies that are culturally, socially, and developmentally appropriate are needed to keep these youth off the streets in the first place.

The sharing of needles among injection drug users (IDUs) is a common route of Human Immunodeficiency Virus and Hepatitis C Virus transmission. Through the increased utilization of social network analysis, researchers have been able to examine how the interpersonal relationships of IDUs affect injection risk behaviour. This study involves a secondary analysis of data from a cross-sectional study of 156 IDUs from Winnipeg, Manitoba titled “Social Network Analysis of Injection Drug Users”. Multiple logistic regression analysis was used to assess the individual and the social network characteristics associated with needle sharing among the IDUs. Generalized Estimating Equations analysis was used to determine the injecting dyad characteristics which influence needle sharing behaviour between the IDUs and their injection drug using network members. The results revealed five key thematic findings that were significantly associated with needle sharing: (1) types of drug use, (2) socio-demographic status, (3) injecting in semi-public locations, (4) intimacy, and (5) social influence. The findings from this study suggest that comprehensive prevention approaches that target individuals and their network relationships may be necessary for sustainable reductions in needle sharing among IDUs. / February 2006

In 2005, suicide was the third leading cause of death among youth 10-24 years of age in the U.S. —accounting for 4,482 deaths. Youth suicide is an important public health problem in the U.S. and research focusing specifically on gender differences is needed and warranted since recent research shows that rates of suicide attempts have increased specifically among young girls. Analyses of the recently released 2007 YRBS data (n=14,041; girls=7,036; boys=6,992) of high school students in 9-12th grades, show that 6.9% of adolescents attempted suicide (9.3% of girls versus 4.6% of boys) and 14.5% seriously considered a suicide attempt (18.7% of girls versus 10.3% of boys). Girls are 2.89 (95% CI: 2.31-3.61) times more likely than boys to report attempting suicide in the past 12 months. Moreover, girls who reported attempting suicide were significantly more likely to also report other risk factors such as depression (OR= 5.74), weapon carrying (OR= 1.48), experiencing intimate partner violence (OR=1.60), being forced to have sexual intercourse (1.72), huffing glue (OR=2.04), and being a minority (OR 1.65). However, boys who reported attempting suicide were significantly more likely to also report weapon carrying (OR=1.66), being forced to have sexual intercourse (OR=2.60), huffing glue (OR=1.63), participating in sports (OR=1.52), depression (OR=10.96), hard drug use (OR=2.18), and being a minority (OR=1.93). Furthermore, analyses of 1991 – 2007 YRBS data revealed that these gender specific risks have remained fairly constant over time. These findings will help guide prevention and intervention strategies to prevent suicide and suicidal behaviors among both girls and boys.